Diabetes

Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. The cause of diabetes continues to be a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles.

There are 23.6 million children and adults in the United States, or 7.8% of the population, who have diabetes. While an estimated 17.9 million have been diagnosed with diabetes, unfortunately, 5.7 million people (or nearly one quarter) are unaware that they have the disease.

In order to determine whether or not a patient has pre-diabetes or diabetes, health care providers conduct a Fasting Plasma Glucose Test (FPG) or an Oral Glucose Tolerance Test (OGTT). Either test can be used to diagnose pre-diabetes or diabetes. The American Diabetes Association recommends the FPG because it is easier, faster, and less expensive to perform.

With the FPG test, a fasting blood glucose level between 100 and 125 mg/dl signals pre-diabetes. A person with a fasting blood glucose level of 126 mg/dl or higher has diabetes.

In the OGTT test, a person’s blood glucose level is measured after a fast and two hours after drinking a glucose-rich beverage. If the two-hour blood glucose level is between 140 and 199 mg/dl, the person tested has pre-diabetes. If the two-hour blood glucose level is at 200 mg/dl or higher, the person tested has diabetes.

Type 2 diabetes is the most common form of diabetes. In type 2 diabetes, either the body does not produce enough insulin or the cells ignore the insulin. Insulin is necessary for the body to be able to use glucose for energy. When you eat food, the body breaks down all of the sugars and starches into glucose, which is the basic fuel for the cells in the body. Insulin takes the sugar from the blood into the cells. When glucose builds up in the blood instead of going into cells, it can cause two problems:

Right away, your cells may be starved for energy.

Over time, high blood glucose levels may hurt your eyes, kidneys, nerves or heart.

Finding out you have diabetes is scary. But don’t panic. Type 2 diabetes is serious, but people with diabetes can live long, healthy, happy lives.

While diabetes occurs in people of all ages and races, some groups have a higher risk for developing type 2 diabetes than others. Type 2 diabetes is more common in African Americans, Latinos, Native Americans, and Asian Americans/Pacific Islanders, as well as the aged population.

Diabetes often goes undiagnosed because many of its symptoms seem so harmless. Recent studies indicate that the early detection of diabetes symptoms and treatment can decrease the chance of developing the complications of diabetes.

Some diabetes symptoms include:

Frequent urination

Excessive thirst

Extreme hunger

Unusual weight loss

Increased fatigue

Irritability

Blurry vision

If you have one or more of these diabetes symptoms, see your doctor right away. You can also take our Online Diabetes Risk Test to find out if you are at risk for diabetes.

Major Types of Diabetes

Type 1 diabetesResults from the body’s failure to produce insulin, the hormone that “unlocks” the cells of the body, allowing glucose to enter and fuel them. It is estimated that 5-10% of Americans who are diagnosed with diabetes have type 1 diabetes.

Type 2 diabetes
Results from insulin resistance (a condition in which the body fails to properly use insulin), combined with relative insulin deficiency. Most Americans who are diagnosed with diabetes have type 2 diabetes.

Gestational diabetes
Immediately after pregnancy, 5% to 10% of women with gestational diabetes are found to have diabetes, usually, type 2.

Pre-diabetes
Pre-diabetes is a condition that occurs when a person’s blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. There are 57 million Americans who have pre-diabetes, in addition to the 23.6 million with diabetes.

You or someone you love has just been diagnosed with diabetes — chances are you have a million questions running through your head. This area of our Web site can help ease your fears and teach you more about living with diabetes or caring for someone with diabetes, and connect you with others affected by diabetes who will listen and share their own experiences.

If you or someone you care for has recently been diagnosed with diabetes, you are no doubt experiencing a range of emotions. Fear, anger, denial, frustration, depression and uncertainty are just a few of them, and are very common. You are not alone. This area of our Web site can help ease your Finding out you or someone you love has diabetes is scary. But don’t panic. Diabetes is serious, but people with diabetes can live long, healthy, happy lives. The links below will direct you to basic information, expert advice and peer support.

Managing your blood glucose

Keeping your blood sugar as close to normal as possible helps you feel better and reduces the risk of long-term complications of diabetes.

Checking Your Blood GlucosePeople with diabetes work to keep their blood sugar as near to normal as possible. Keeping your blood sugar in your target range can help prevent or delay the start of diabetes complications such as nerve, eye, kidney, and blood vessel damage.

Tight Diabetes ControlKeeping your blood glucose levels as close to normal as possible can be a lifesaver. Tight control means getting as close to a normal (nondiabetic) blood glucose level as you safely can.

A1C TestAn A1C test gives you a picture of your average blood sugar control for the past 2 to 3 months. The results give you a good idea of how well your diabetes treatment plan is working.

Life with Type 2 diabetes can as enjoyable and full as life without it. The keys to living with diabetes include the proper medication and medical treatments, eating the right foods, getting the proper type and amount of exercise and managing stress.

Make a commitment to managing your diabetes. Learn all you can about type 2 diabetes. Make healthy eating and physical activity part of your daily routine. Establish a relationship with a diabetes educator, and ask your diabetes treatment team for help when you need it.

Identify yourself. Wear a tag or bracelet that says you have diabetes. Keep a glucagon kit nearby in case of a low blood sugar emergency — and make sure your friends and loved ones know how to use it.

Schedule a yearly physical exam and regular eye exams. Your regular diabetes checkups aren’t meant to replace yearly physicals or routine eye exams. During the physical, your doctor will look for any diabetes-related complications, as well as screen for other medical problems. Your eye care specialist will check for signs of retinal damage, cataracts and glaucoma.

Keep your immunizations up to date. High blood sugar can weaken your immune system. Get a flu shot every year, and get a tetanus booster shot every 10 years. Your doctor will also likely recommend the pneumonia vaccine.

Take care of your teeth. Diabetes may leave you prone to gum infections. Brush your teeth at least twice a day, floss your teeth once a day, and schedule dental exams at least twice a year. Consult your dentist right away if your gums bleed or look red or swollen.

Pay attention to your feet. Wash your feet daily in lukewarm water. Dry them gently, especially between the toes, and moisturize with lotion. Check your feet every day for blisters, cuts, sores, redness or swelling. Consult your doctor if you have a sore or other foot problem that isn’t healing.

Keep your blood pressure and cholesterol under control. Eating healthy foods and exercising regularly can go a long way toward controlling high blood pressure and cholesterol. Medication may be needed, too.

If you smoke or use other types of tobacco, ask your doctor to help you quit. Smoking increases your risk of various diabetes complications, including heart attack, stroke, nerve damage and kidney disease. In fact, smokers who have diabetes are three times more likely to die of cardiovascular disease than are nonsmokers who have diabetes, according to the American Diabetes Association. Talk to your doctor about ways to stop smoking or to stop using other types of tobacco.

If you drink alcohol, do so responsibly. Alcohol, as well as drink mixers, can cause either high or low blood sugar, depending on how much you drink and if you eat at the same time. If you choose to drink, do so only in moderation and always with a meal. The recommendation for women is no more than one drink daily, and for men, no more than two drinks daily.

Take stress seriously. If you’re stressed, it’s easy to abandon your usual diabetes management routine. The hormones your body may produce in response to prolonged stress may prevent insulin from working properly, which only makes matters worse. To take control, set limits. Prioritize your tasks. Learn relaxation techniques. Get plenty of sleep.

Above all, stay positive. Diabetes is a serious disease, but it can be controlled. If you’re willing to do your part, you can enjoy an active, healthy life with type 2 diabetes.

Find answers to common basic concerns associated with being recently diagnosed, and learn about diabetes conditions, treatments and complications by following the links below:

Type 2 diabetesType 2 diabetes is the most common form of diabetes. In type 2 diabetes, either the body does not produce enough insulin or the cells ignore the insulin.

Pre-diabetesBefore people develop type 2 diabetes, they almost always have “pre-diabetes” — blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes.

Diabetes Myths
Find the truth about some of the most common myths about diabetes.

Common ConcernsThis section addresses various areas to help you live with type 2 diabetes. What do you do when you’re sick? What do you do when you travel? Can you get a flu shot with diabetes? How do you cope with having type 2 diabetes? Are you being discriminated against because you have diabetes? You’ll find answers to these questions, and more in this section.

Alzheimer’s disease is the most common cause of dementia — the loss of intellectual and social abilities severe enough to interfere with daily functioning. In Alzheimer’s disease, healthy brain tissue degenerates, causing a steady decline in memory and mental abilities.

Alzheimer’s disease is not a part of normal aging, but the risk of the disorder increases with age. About 5 percent of people between the ages of 65 and 74 have Alzheimer’s disease, while nearly half the people over the age of 85 have Alzheimer’s.

Although there’s no cure, treatments may improve the quality of life for people with Alzheimer’s disease. Those with Alzheimer’s — as well as those who care for them — need support and affection from friends and family to cope.

Alzheimer’s disease may start with slight memory loss and confusion, but it eventually leads to irreversible mental impairment that destroys a person’s ability to remember, reason, learn and imagine.

Memory loss

Everyone has occasional lapses in memory. It’s normal to forget where you put your car keys or to blank on the names of people whom you rarely see. But the memory problems associated with Alzheimer’s disease persist and worsen. People with Alzheimer’s may:

Repeat things

Often forget conversations or appointments
Routinely misplace things, often putting them in illogical locations
Eventually forget the names of family members and everyday objects
Problems with abstract thinking
People with Alzheimer’s may initially have trouble balancing their checkbook, a problem that progresses to trouble recognizing and dealing with numbers.

Difficulty finding the right word

It may be a challenge for those with Alzheimer’s to find the right words to express thoughts or even follow conversations. Eventually, reading and writing also are affected.

Disorientation

People with Alzheimer’s disease often lose their sense of time and dates, and may find themselves lost in familiar surroundings.

Loss of judgment

Solving everyday problems, such as knowing what to do if food on the stove is burning, becomes increasingly difficult, eventually impossible. Alzheimer’s is characterized by greater difficulty in doing things that require planning, decision making and judgment.

Difficulty performing familiar tasks

Once-routine tasks that require sequential steps, such as cooking, become a struggle as the disease progresses. Eventually, people with advanced Alzheimer’s may forget how to do even the most basic things.

Personality changes

Doctors can accurately diagnose 90 percent of Alzheimer’s cases. Alzheimer’s disease can be diagnosed with complete accuracy only after death, when microscopic examination of the brain reveals plaques and tangles.

To help distinguish Alzheimer’s disease from other causes of memory loss, doctors typically rely on the following types of tests.

Lab tests

Blood tests may be done to help doctors rule out other potential causes of the dementia, such as thyroid disorders or vitamin deficiencies.

Neuropsychological Testing

Sometimes doctors undertake a more extensive assessment of thinking and memory skills. This type of testing, which can take several hours to complete, is especially helpful in trying to detect Alzheimer’s and other dementias at an early stage.

Brain scans

By looking at images of the brain, doctors may be able to pinpoint any visible abnormalities — such as clots, bleeding or tumors — that may be causing signs and symptoms. Positron emission tomography (PET) can reveal areas of the brain that may be less active and the density of amyloid plaques.

Magnetic resonance imaging (MRI)

An MRI machine uses radio waves and a strong magnetic field to produce detailed images of your brain. You lie on a narrow table that slides into the tube-shaped MRI machine, which makes loud banging noises during scans. The entire procedure can take an hour or more. MRIs are painless, but some people feel claustrophobic in the machine.

Computerized tomography (CT)

For a CT scan, you lie on a narrow table that slides into a small chamber. X-rays pass through your body from various angles, and a computer uses this information to create cross-sectional images, or slices, of your brain. The test is painless and takes about 20 minutes.

Positron emission tomography (PET)

During a PET scan, you’ll be injected with a low-level radioactive material, which binds to chemicals that travel to the brain. You lie on a table while an overhead scanner tracks the radioactive material. This helps show which parts of your brain aren’t functioning properly. The test is painless and can be particularly useful in distinguishing between different types of dementia.

Often, as Alzheimer’s disease progresses, people experience depression, agitation and psychotic symptoms (paranoid thoughts, delusions or hallucinations).These behaviors may be manifested verbally (screaming, repetitive questions, etc.) or physically (hoarding, pacing, etc.), and they can sometimes lead to aggression, hyperactivity or combativeness. The symptoms may have an underlying medical origin such as a drug interaction or physical pain, and if this is a suspected cause a physician should be consulted. Agitation or psychotic behavior may also be triggered by something different in the person’s environment. Often, a change in routine, caregivers or surroundings can cause fear, anxiety or fatigue and lead to agitation.

The individual may be unable to communicate, be frustrated by his or her limitations, misunderstand what is happening or simply forget how to respond appropriately. In these cases, non-medical intervention is recommended to determine the source of the problem, modify the environment and change the behavior. If non-medical intervention does not work or the person becomes a danger to himself or others, a physician should be consulted to evaluate the need for medical treatments for depression, psychosis or anxiety.

A healthy lifestyle may help prevent or postpone the development of Alzheimer’s disease. Because Alzheimer’s is most common in people over the age of 80, delaying the onset of the disease would increase the probability that people will die of other causes before Alzheimer’s has a chance to develop.

Eat your veggies

Maintaining a healthy weight and eating a healthy diet appears to reduce the risk of developing Alzheimer’s disease. Your doctor may suggest:

Lots of fruits and vegetables

Fish or poultry, instead of red meat

Whole-grain breads and cereals

Alternate sources of proteins, such as beans, nuts and seeds

More olive oil and less saturated fat

Exercise your body

Higher levels of physical activity have been associated with a lower incidence of Alzheimer’s disease.

Exercise your brain, too

Maintaining mental fitness may delay onset of dementia. Some researchers believe that lifelong mental exercise and learning may promote the growth of additional synapses, the connections between neurons, and delay the onset of dementia.

Carry a reminder calendar.

Record not just upcoming events, but things that happen and activities you need to complete on a daily basis. And check off those activities when done. If you can make this process a habit before your memory problems worsen, you’ll be more likely to retain this skill as the disease progresses. If you can’t remember if you took your pills or who called that morning, you can check your journal.

People with Alzheimer’s disease often experience a mixture of emotions — confusion, frustration, anger, fear, uncertainty, grief and depression.

You can help a person cope with the disease by being there to listen, reassuring the person that life can still be enjoyed, providing unconditional love, and doing your best to help the person retain dignity and self-respect.

A calm and stable home environment reduces behavior problems. New situations, noise, large groups of people, being rushed or pressed to remember, or being asked to do complicated tasks can cause anxiety. As a person with Alzheimer’s becomes upset, the ability to think clearly declines even more.

Caring for the caregiver

Providing care for a person with Alzheimer’s disease is physically and emotionally demanding. Feelings of anger and guilt, frustration and discouragement, worry and grief and social isolation are common. If you’re a caregiver for someone with Alzheimer’s disease, you can help yourself by:

Asking friends or other family members for help when you need it

Taking care of your health

Learning as much about the disease as you can

Asking questions of doctors, social workers and others involved in the care of your loved one

Joining a support group

Many people with Alzheimer’s and their families benefit from counseling or local support groups. Contact your local Alzheimer’s Association affiliate to get connected with support groups, doctors, resources and referrals, home care agencies, supervised living facilities, a telephone help line, and educational seminars.

If you need more information on Alzheimer’s, the internet is a great source of information on this subject and many, many more. You may also want to search the internet for social networking sites about Alzheimer’s disease. Many of the social network sites can connect you with people who have gone through or are going through what you are experiencing.